HEALTH TRAIN EXPRESS
Follow or subscribe to Health Train Express as well as Digital Health Space for all the updates for health policy, reform, public health issues. Health Train Express is published several times a week.Subscribe and receive an email alert each time it is published. Health Train Express has been published since 2006.

No more than 6 #tags, No more than 5 @s, No more than 3 hyperlinks/blog post, Clean my gmail archives, review my Facebook app authorizations, Defragment my hard drives, Not update Windows 7 to Windows 8 for at least one year after it is released. Replace my aging router. Replace my aging laptop. And add an iSomething or other.

Spread cheer, humor, understanding and humility to all friends, love my enemies, obey my spouse, try to understand my children (now young adults) and remember that was me 40 years ago.

There are many more do not does and does, but I have a hand cramp.

I declare tomorrow December 31, 2011 as the last day of 2011 (by the powers vested in me?)

Facebook study reveals deeper penetration of social media into healthcare than most would have predicted.

Patients seem more willing to adopt social media platforms that healthcare professionals.

It seems that patients will classify certain health related problems according to social acceptability, fears of retribution by friends, or employers or merely embarrassment.

STDs appear to be highest on the list followed by cancer, neurologic problems such as aging, dementia, or mild strokes and/or memory loss. Some parents do not want their children to know about serious or potentially fatal illnesses..

During my own social media contact with people (not my own patients) they will often inquire about their illnesses and express a desire to contact their physicians office for an initial encounter, even before a telephone contact.

Their may be several factors operating.

1. It offers bypassing clerical personnel, either by shortcutting a wait on the telephone, via telephone triage. It also offers after hours communications.

2. It depersonalizes the initial contact with a non-medical person, who they do not want to know about a personal problem.

3. Some have expressed a brief social media contact with the doctor would alleviate anxiety while waiting for an appointment.

4. Some perceive a professional social media contact as an act of caring and would offer a means of expressing anxiety, which might facilitate an earlier office visit.

5. The acceptance of these forms of communication have been limited by the feds. Ethics have been replaced with law.

6..Google + hangouts it turns out is not a secure platform, nor would an application on top of it be secure.

Wednesday, December 28, 2011

It is more difficult to maintain your privacy if you use the internet, even for something seemingly as benign as email or Google.

Google is more ubiquitous than the yellow pages and is far more accessible.There are many analytics engines sweeping Google, twitter, Facebook and other social media for statistics and trends in internet use ranging from your network size, who influences you,who you influence, your areas of expertise and other unmentionables. Klout is one site that you can access to have some idea of what analytics is capable of assessing about your internet usage. Most of these programs are free with limited functionality but for a price a much more invasive biopsy of your presence is available.

Real WIMAX, (not 4G that delivers speed but not distance) may deliver on broadband health IT in remote and rural areas of the United States.

The FCC (Federal Communications Commission) is in the process of releasing “white space”, the television analog frequencies abandoned by the fiat of the FCC several years ago. The white space will be used for ‘Wi-Max” a wide area VHF wireless technology that has the potential for a 60 mile radius with one or several broadcast points. While the power limitations are very low and the speeds are low, it will enable much better coverage in rural areas at much lower cost. The adapters are simple and quite inexpensive, the first rendition that has been approved is from Koo Technologies.(KTS) I believe this will enable rural providers and hospitals to tie into the NHIN easily. The first test markets are in Delaware and Washington, D.C., and rural Virginia. Spectrum Bridge is an early provider for the technology.The technology requires a database search for unused spectrum so that it does not interfere with other users in that portion of the radio spectrum. More details here (download).

The innovation will have a great effect on healthcare, as much as scientific advances in medicine. Connectivity has been rated in the top 10 of the best advances in medicine by USA News.

Top 10 Medical Breakthroughs: This one is a little more difficult to list. There are a number of determinants, such as basic science, specialization, public health and others which will effect efficiency and cost savings.

Tuesday, December 27, 2011

It seems no matter where you look on the internet the buzz this year has been about social media. Health care is no exception and there are many beating the band how valuable and perhaps essential it will become in the future.

Much of it will be dependent upon users preferences for efficiently using limited resources, the most important of which is time.

For physicians personally time is the most critical limiting factor. The use of social media is financially negligible unless one chooses a social media manager to direct it’s operations. The necessity for this is dependent upon how much resource your organization has to handle this task.

The capital investment is close to zero.

Physicians can easily acquire the knowledge on how to limit breaches in privacy and confidentiality, and that can be passed on to workers in training.

There is some reason to believe that social media adoption may be approaching it’s limits due to time constrictions for employed people. And doctor you fit in to that equation. Your best income producing time is in the clinic seeing patients, or in the surgery doing procedures.

Hands on marketing for professionals between professionals is best done hands on face-face, in meetings, making rounds, lecturing for CME, taking an ER patient that is difficult or challenging due to insurance issues. The referring physician will forever be grateful, you will help a patient (even if you have to later refer him to a public facility later) and you may get some patients from the source that is insured or will pay a reduced fee.

So in reality you are already in social media….the difference is social media is also on the internet..digital social media.

Most users already are aware of many forms of social media, the most common ones being twitter, and Facebook. These two are unique and function differently although the same information can be exchanged in different ways.

Twitter has become a means of announcing and reporting medical meetings broadcasting tweets using a hashtag assigned for that particular meeting, as I have previously reported in a previous blog. It may be advisable for those developing annual meetings to assign a # such as AMA11 to designate a 2011 American Medical Association meeting, then changing it to AMA12 for next years meeting. Different Academies may also use their abbreviations as such but should take care to be certain it has not already been pre-empted or users will receive some unwanted tweets.

Case in point. Your employee who has been handling your social media leaves and takes with her social media information which may be proprietary in nature or take with him (her) the following they have developed in your social media stream. Who owns the content? That may depend on the nature of the conversation? Was it friend to friend or was it medical, marketing or financial information belonging to the medical practice.

Legal counsel may be advisable and also a clear guideline in your employee manual in regard to content using your identification on Twitter, Facebook, Google + or any of the social media platforms

Courts Says Employer's Lawsuit Against Ex-Employee Over Retention and Use of Twitter Account can Proceed--PhoneDog v. Kravitz

Bloggers themselves know that relying on a single tool isn’t effective, they need a series of tools to use; “blogging isn’t dead. it may have gotten a LOT more social, and it may be less frequent now for those of us who also use Twitter / Facebook / Tumbler / YouTube for other distribution efforts, but the overall impact from these platforms together is BIGGER than ever before (and i maintain, also EASIER than ever before if you build it right).”

Thursday, December 22, 2011

Amazing as it seems the latest survey reveals that up to 80% of physicians use one form or another of social media to interact with patients. This despite precautionary warnings about patient privacy and confidentiality.

The study did not reveal what form of social media they use; email, instant messaging, twitter, Skype or secured Google cloud documents. Google Cloud documents can be locked except for the intended readers.

Business uses the cloud for secure transactions and sensitive data, and there will be no shortage of offerings for medical applications. In fact, the cloud may offer a more cost effective and usable platform for a national health information exchange rather than re-inventing the wheel.

Now there is a new fast growing platform, Google + and even more revolutionary is Google + Hangouts.

Google plus Hangout and Sexual Ambiguity

The following topic was discussed on a public hangout broadcast by a public television station, KOMU TV in Colombia, Mo. Anchorwoman Sarah Hill is a pioneer in the convergent media space. She discusses a personal sensitive issue with Maya Posch born as a hermaphrodite. You will notice the film strip below the large screen of the Hangout participants. The ability to express herself with support from a public audience obviously gives this person hope.

Part I Interview with Maya Posch

Part II Interview with Maya Posch

The scope and power of social media cannot be underestimated among patients who share serious medical issues with like individuals. Caution, the content may be offensive to non-medical viewers. As mentioned in a portion of the video civil rights are part of the challenge in sexual ambiguity.

Health care is now much like a village, or perhaps a group of villages which need to communicate. The convergence of the internet and television, have created a new milieu. Internet or streaming video may replace classical Television much like over the air TV was replaced by satellite or cable.80% of cable television users also hold a hand held device in their hands while viewing news or entertainment programs. They are frequently polled while watching, straw votes are taken during election campaigns.

The potential is great for social media for two way interaction with doctor and patient using interactive teaching sessions for patients from your office, or clinic regarding diagnoses, treatment course and for monitoring patient compliance.

With the support of Health Train Express Google product developers will develop a new platform, an API dedicated to a Google Medical Application, yet to be named.

Google, in it’s infinite wisdom designed the Google+ platform to be secure on a one to one circle share. It is possible to telehealth one to one. Images are of high quality. The medium is extremely cost effective, free for the moment.

The project will take several months to complete, and you may read about it here when it is ready for a beta release. Please subscribe to Health Train Express or use an RSS feed to see the announcement.

We are looking for suggestions and contributions about what functionality you would like to see in the new Google Medical API. Please tweet me @glevin1 or email me at riversideeyemd@gmail.com

Wednesday, December 21, 2011

“The Obama administration Monday named 32 health care systems across the country as “Pioneer” ACOs. These will be the first places to test out the new payment model; they’ll provide a bit of a sneak peak at what it could mean for the rest of the country. In other words, we may soon see our first unicorns.

Unicorn, or not it is interesting that they chose 30 health systems which are already business entities and well integrated health systems. They are also located in unique health care markets.

Jim Hinton, President and CEO of Presbyterian Health System (one of the lucky 30 chosen makes these remarks in the Washington Post article authored by Sarah Klif.

“Jim Hinton: Health care has grown up in a fee-for-service system, and it’s also grown up with a system where the primary unit is an individual doctor taking care of an individual patient. At Presbyterian, we’ve been working on making care more integrated for 20 or so years now and have been able to do a lot by operating our own health plan..

A lot of what [the Accountable Care Organization model] does is build a system of care where there’s a safety net and we can help advocate for the patient. We’re looking at how can we do more with nurses and other advance practice professionals. How can we use technology? How can we change the visit model so its not one patient with one doctor every 15 minutes?

He offers some creative solutions for extending benefits such as home health care by up regulating it to a ‘home hospital’, reducing the cost of in patient hospitalization, but increasing the amount of home health care. To me this just seems to be cost shifting and would require major re-designs of accounting for the ACO.

All of these proposals are well hidden in the PPACA and the net effect is going to take a decade or more to be studied.

We’re experimenting with some group visits with doctors, and also another program where we hospitalize people in their homes. One good metaphor is thinking about it as if you were going to remodel your house. If you had a plumber, carpet-layer and someone putting down tiles not talking to each other, the house might not turn out very well. The idea is to anchor all the care in one place, where there’s a lot of coordination.

Mr Hinton summarizes it well for the rest of medicine.

““SK: As you mentioned earlier, your health system has been working on moving toward more integrated care for over 25 years now. What about the health care providers that haven’t been working on this stuff? How well do you think they’ll be able to use these new incentives?

JH: My colleagues who come from systems that have not owned managed care organizations are trying to assess how they can accelerate into this mindset. Most hospital systems today have some experience employing physicians but I think there are still two big barriers in going towards more integrated care. One is bringing an insurance perspective to populations, where you’re managing care and managing risk. The second is a cultural one. Many health care providers have fee-for-service as one of their core business models. It’s hard to get away from this notion that doing more health care means earning more money”

I do not see ACOs catching fire in much of medicine. In fact I predict that smaller towns will continue on their current merry way. Some ACOs may very well have to contract out some professional services depending on the willingness of the physician community to forfeit freedom and independence. This will invoked the laws of secondary consequences with it’s attendant unforeseen challenges.

Physicians resistant to ACOs may very well boycott a local ACO if given that alternative.

Monday, December 19, 2011

Contrary to what poor or affluent people think, money does not solve all problems of health care, and it will never stop the issues of caring for one another in a health system.

I believe the entire national budget could be thrown at health care and there would still be a problem of ‘not enough money’. There is more than enough funding to maintain good health, wellness and treat those who are no longer healthy and/or well.

Precious resources are expended on studies, fighting fraud and abuse, having analysts draw graphs that either intersect dangerously at some time in the future, or have in the past. My favorite one is the exponential graph rising vertically into infinity.

The issues are much like the impasse about the debt ceiling. Political expediency and prostituting opinions for votes. We ask politicians to make decisions from false economics, and figures that may be highly inaccurate, against a setting of voting on issues they know nothing about except how it affects a state or federal government.

Case in point is the current conflict about mandated insurance coverage.

Much has been said about using the current medi-caid system to fill in the blanks. This is a more than stupid idea for many reasons.

1 The current system is not designed nor can it accommodate more patients.

2. The current system in many states do not have enough providers to service the huge increase in patients.

3.. The current system is not designed to care for patients. It is cumbersome and designed to deny care for any possible reason, financial, missing paperwork, or a vacant modifier in the billing codes.

4. The current system does not respond to market indicators, and reimbursement methodology is byzantine.

Saturday, December 17, 2011

Like the airlines, who are not too big to fail, medical practices will need to find ways to increase revenues. It’s too bad our patients don’t carry baggage into our offices so that we could have a surcharge modifier such as –0000 for each item.

However physicians can emit a sigh of relief with the announcement from on high at HHS, as brought to us by the American Medical Association, in AMED News. Included in that news are:

Physicians meeting criteria in 2011 to earn federal electronic medical record incentives will have more time before the Dept. of Health and Human Services requires them to satisfy tougher standards for attaining additional bonuses. The move is being viewed by physicians and health policy observers as a goodwill gesture by the Obama administration toward EMR early adopters. ( Who cares what Obama thinks about goodwill? The AMA ?)

True to form modifications are being made to the calendar for implementation-incentive reward-penalty dates because the initial proclamations and mandates were poorly planned. What we have in the federal government is a group of “cheerleaders’ encouraging the workers how much health IT will improve patient care. Even the AMA buys into that.

No Doctor Left Behind ? This sounds much like the Bush Plan of No child left behind.

Public health studies have shown that more doctors want to participate in the EMR adoption program. A study from the Centers for Disease Control and Prevention found 52% of office-based physicians plan to register and attest to meeting program requirements for 2011, which is an increase from the 41% who planned in 2010 to do so. The total portion of physicians who have adopted EMRs also is at 34% in 2011, up from 17% in 2008.

It takes a lawyer to make the following statement,

“

“There are several takeaways for physicians from Sibelius' announcement,” said Stephen Bernstein, an attorney who is the international head of the health industry practice group at McDermott Will & Emery in Boston. In general, more physicians are adopting EMRs and using the technology to improve their practices.

“HHS also is sending a message to physicians who are undecided about whether they should make a significant investment in electronic recordkeeping”, Bernstein said. “The agency will work with physicians to help them adopt EMRs”. He suggested that doctors get in touch with one of 62 federal regional extension centers that have been established to help physicians, in particular small primary care practices, adopt EMRs.

"The main message is that there are federal government programs out there to help physicians, and the federal government isn't going to stop offering help," he said.

“It’s okay, we are here from the government to help you.” (author)

Bernstein added that a robust EMR system is needed to participate in new Medicare payment models, such as accountable care organizations. If CMS wants physicians to participate in these initiatives as well, it must do everything it can to encourage doctors to use EMRs, he said.

It’s a bundled plan, just like reimbursements. Step C is dependent on steps A and B. (If they work in the first place)

Clearly it is disruption disrupting disruption. Even chaos theory fails to keep up with these advances in advanced health care physics.

The incentive program is clearly aimed at primary care MDs, and the recent statistics reveal it.

Specialty # Participating in Bonus

Family practice 1,216

Internal medicine 1,198

Cardiology 517

Podiatry 378

Gastroenterology 232

Orthopedic surgery 201

General surgery 197

Urology 197

Nephrology 174

Neurology 148

Other 1,347

What Medicaid Paid for EMR Bonuses

Physician 6,609 $138.5 million

Nurse practitioner 1,463 $31.1 million

Acute care hospital 607 $483.9 million

Dentist 333 $7.1 million

Certified nurse midwife 172 $3.7 million

Physician assistant 107 $2.3 million

Children's hospital 15 $45.1 million

What is even more worrisome is the profound recession we are experiencing, the HHS emphasizes the ARRA and Hitech have produced 50,000 job…a mere drop in the bucket. Our budget deficit is crippling planning at the federal and state level….

Wednesday, December 14, 2011

Another bold innovation (and why didn’t I think of this before?) The beauty of this is that it offers another functionality to the iPad form factor. without the burden of extra parts. Although the iPad offers a keypad feature, users complain there is no tactile feedback which touch typists use unconsciously to type. And the addition of an external keyboard adds to more clutter.

This flexible plastiform rubberized overlay is held in place by magnets which attack to the border of the iPad’s frontface. It gives the user tactile feedback much like a normal keyboard. It also has other features attaching it to iPads official cover.

All in all a dandy device for the clinic, by the bedside or in the hospital.

Tuesday, December 13, 2011

Monitoring the social media stream today in #hcsm #medicine #healthreform and find that Facebook will offer a page and/or referral to FBers who are depressed and suicidal. Is this the first step into Health 2.0 and is social media going to bypass formal developments in the Health 2.0 Challenge?

Mobile apps already support API for all the social media platforms, twitter, facebook, and Google +. Twitter is very restrictive as to which APIs can use twitter’s API however health 2.0 would gain them many more users that do not compete with Twitter’s plans.

I predict that Social media will bypass the present vision for formal health 2.0 apps, and developers should re-think their game plans or be left behind even before it happens.

G+ offers the potential for telehealth with video and it should not be hard for programmers to build a secure encrypted API to comply with HIPAA. It is accessible on smartphones, iPads and many tablet PCs.

I held a G+ hangout on Tuesday night at 6PM. The attendance was zero. A big disappointment but not a surprise at all. Not many MDs and few #hcsm users are on Google + Experience reveals it takes about one month for the stream to capture interested social media participants.

Google + has a predominance of artists, performers, and photographers. Even if you don’t want to hangout in health care…it is a broadening experience and revealing as to how much talent there is besides American Idol and the network cable offerings.

Health Train is the most prominent MD and health related +er on Google.

You can find Health Train’s profile on Google + at the Google ID. Join and put me in one of your circles. Hope to see you all there.

Monday, December 12, 2011

Webcina announced it’s winners for their contest for social media participants. Although Healthtrain Express failed to make it to the podium I enjoyed participating and ‘spilling my beans”. My reward was to be able to read these fine stories..Stories that should excite all of us in social media.

I read the winning blog posts, and found them all to be far better in appeal and content than my illiterate meanderings.

Suzanne Ezekiel’s Journey Her contribution includes her vivid youtube video portraying the effects of her disease. It is one of the most telling and vivid descriptions that leaves the observer breathless and battered. It probably should receive some type of award in videography and story content.

Sunday, December 11, 2011

Just like my office walk ins are always accepted. The same here on the Health Train Express….my plan for a subject often changes drastically when I surf the web, check my tweet box, Facebook, and Google +.

Healthcare is not all that unique. I find similar challenges in business on Google +, Facebook, LinkedIn and Twitter. Business is also perplexed just what to do with social media. In healthcare there remains a large part of the workforce that are neophytes with health information technology and how to use it. Questions arise about return on investment with EMRs, Health Information Exchanges, Outcome studies, and Analytics. The jury will be out for several or more years for many reasons. Statistics have a way of flowing in slowly however with the modernization of systems and new software that will take a set of tables, and charts and transform them into an easily understood graphic understanding sheer numbers may turn into a video-game like presentation.

As in healthcare business is challenged as to what portion of social media to exploit, where, and how much. Like electronic medical records the work force must be trained in social media.

Saturday, December 10, 2011

Do you remember in days of old the train conductor would come by and punch your ticket. The shape of the punch hole looked quite a bit like # .

# now represents the hashtag on twitter as well as other social media platforms.. Speaking from my anecdotal story of one in the cohort, I found them to be confusing at first, especially if there was a hashtag salad of multiple #s.

The Hashtag Project. Hashtag Project is organized and administered by the Foxepractice.com Consulting Firm. In addition to their epractice modules and advice on Web 2.0 they provide a full menu of services. If you don’t have time yourself to dive into social media (and few doctors do) they can set you up and your staff can do the daily operations. Put your efforts into your own area of expertise.

The proper use of a hashtag allows others to search the twitter stream for your subject, #hcsm is the most often used tag for medical issues, and there are also specific hashtags for medical meetings. ( a topic I covered in one of my recent blog posts).

Recent analysis of social media in medicine reveals some positive dividends and a return on investment, according to FiercePractice Management. One primary care physician attributes 30 new patients/month from social media engagement prior to an office visit, conservatively estimating a $125,000 annual return on his $60 investment.

According to the update from online physician learning collaborative QuantiaMD, 87 percent of physicians make personal use of social media, while 67 percent use it professionally.

The QuantiaMD report also indicates that most physicians using social media are heeding to best practices, with 75 percent of those who've received friend requests from patients saying they declined. While challenges persist in navigating the best ways for physicians to use sites such as Facebook, Twitter, Google+ and the like, some doctors who've dipped a toe in the water report unexpected advantages.

Natasha Burgert MD, a pediatrician committed to one year of social media with surprising results as published at Pediatric Inc

On Monday evening, 6PM PST December 12, 2011 there will be a Google + Medical Hangout. If you would like to attend send me an email gmlevinmd@gmail.com or tweet @glevin1

Friday, December 9, 2011

Some of you already know about Zdogg and Dr. Harry, so this may seem lame, but for those of you who have not seen them, they are the “rappers” of medicine.

On another front, today I held the first Google + Medical Hangout with a friend +Bruce Garber (with his waiver regarding HIPAA). He had an eye problem which I was able to diagnose using Google + Hangout with an ordinary webcam. If your webcam is good enough with HD and you have a good video graphics card, it works well.

I hope you will all join me tonite at 5PM PST for my medical hangout on Google +. Let me know what prominent doctors you would like to be in the hangout and I will invite them for tonite or next Friday nite. You are all invited to participate. Admission is FREE !!!

I spend an inordinate amount of time on social media, Google + and Google Hangout in particular. Most of the time on sites relevant to healthcare and medicine. I also attend events worldwide on SM in general, research large business consulting firms such as Forrester. Now and then I bump into a Presidential candidate. Watch this one, and you might see me.

Speak withi a Presidential Candidate from the comfort of your Couch at Home

Facebook and Twitter serve some specific needs that I use for messaging and communicating one on one. Many of my followers are not at all familiar with Google +

I am here visiting the LeWeb Conference in Paris France. This is the Euro-Web event.and my G+Stream as well as Tweetdeck.are busy. I also am using a social media browser, RockMelt which aggregates twitter, facebook, and several of my favorite RSS feeds.

Rockmelt also facilitates customization of website you visit frequently. The page is simplistic with most of the desired links on the left banner. I can switch from web sites to a social media site very quickly.

Is all this social media relevant? I think it is, as a tool and for some as a revenue stream, and information stream.

The roster of presenters reads like the Who’s who of software application developers and famous internet entrepreneurs.

Today at the LeWeb Conference, Marisa Meyer (Google +) pointed out that Social Media is “green”. Conferences and social media interact to decrease travel to meetings, Forrester Gartner, business consultants predict that social media is running out of time (limits of time available), and running out of people…Social Media is in a bubble. SM will have to be more efficient…the next wave will be faster, easier to use and have a higher value per unit of time.

In the Enterprise (Hospitals, Integrated Health Systems, Universities) tremendous growth is taking place, newer platforms, and for professional services. SM will become the central hub with radiating spokes to the cloud, to mobile apps and classical desktop services. These changes are taking place rapidly in business, healthcare is a laggard (as usual).

Anyone who attends a social media event comes away excited, either because of the energy of the presenters, or because of the ideas for applications in health care, which at present remain unfulfilled.

In a parallel universe the occupy movement reflects the earliest indicator of looming change for business, government and healthcare. The old paradigms will disappear with the ineffectual systems we now use.

Is healthcare boring? No, but healthcare systems are staid and about to face the apocalypse of Armageddon.

All experts advise not rushing in to social media where only fools dare to tread. Adequate preparation, education and training are essential to prevent damage to your brand or reputation. The analogy is ‘screaming in the middle of the room to get attention”.

It is very much like choosing an electronic medical record…choosing the wrong one or how to use it can be a disaster and have a negative effect.

Wednesday, December 7, 2011

In a case that’s sending a frightening message to the blogger community, a U.S. District Court judge ruled that a blogger must pay $2.5 million to an investment firm she wrote about — because she isn’t a real journalist.

Judge Marco A. Hernandez said Crystal Cox, who runs several blogs, wasn’t entitled to the protections afforded to journalists — specifically, Oregon’s media shield law for sources — because she wasn’t “affiliated with any newspaper, magazine, periodical, book, pamphlet, news service, wire service, news or feature syndicate, broadcast station or network, or cable television system.”

The Obsidian Finance Group sued Cox in January for $10 million for writing several blog posts critical of the company and its co-founder, Kevin Padrick. Obsidian argued that the writing was defamatory. Cox represented herself in court.

The judge threw out all but one of the blog posts cited, focusing on just one (this one), which was more factual in tone than the rest of her writing. Cox said that was because she was being fed information from an inside source, whom she refused to name.

The debate over whether bloggers are journalists has been going on for years, but the consensus has been largely settled — on the opposite side of what Judge Hernandez has ruled. Attorney Bruce E. H. Johnson, who wrote the media shield laws in next-door Washington State, told Seattle Weekly that those laws would have protected Cox had her case been tried in Washington.

Will Medicare sue a blogger? How about Aetna, or Humana, or Blue Shield?

Tuesday, December 6, 2011

Regina Holliday brings to life in her art work much of the confusion in healthcare and the misery and heartache it brings to patients.

If you have been to a medical meeting she is the lady in the back intently painting her reaction to the subject of the meeting. I’ve known about Regina Holliday for several years. Although we have never met, I hope someday to meet her, I feel I know her well and her family as well.

I want to share her latest art work which she has shared on her Facebook pages.

Here are some of her paintings, and her comments:

Halloween night:

“I boarded an Airplane at 7:30pm at Regan National on October 31st still wearing my Wizard’s Robes. I spoke the next morning before the folks at OCHIN. My Presentation was called Trick or Treat, and I wove references to Halloween throughout the speech.

I then began to paint. I painted in two sessions in the morning. The painting is called: “50%.”

I saw the first presentation “Integrating Mental Health into Primary Care,” delivered by Tami Hoogestraat, Psy. D., M.B.A. and Demetrio Sanchez, MSW-OHSU, Richmond Mental Health Integration Team. I was very impressed by their slides. An early one really caught my eye with its statistic: “50% of mental health problems are missed in primary care.”

“In this painting the patient is divided in half just like our statistic. Half in darkness half in light he clutches his medical home. The medical home is colored like and reminiscent of a Monopoly house. It is an ideal but will not work without a supported reimbursement model. “

To the left of our figure the spider web diagram of integrated care places the patient in the center. But this no comforting circle enclosing clinical text. Here the patient looks up staring at the viewer whilst frightened. Practitioners that are trying to care for him surround him. I added other threads crossing the path of the diagram to the other care agents and detriments in the man’s life, be they friends, foes or family.”

Here patients race up a stairs trying to make their appointment time. A mother glances nervously at her watch as she hurries her child up the stairs. A doctor waits at the top reaching out to the registered patients with one hand. In the other he hoists a rope that ends in a watch. A patient in an examination robe strenuously climbs the rope. She is not scheduled but direly needs care, and the doctor is trying to fit her in, hence the term advanced access.

I decided to take the OCHIN logo and modify it to a Meaningful Use Sun image. So a logo tree becomes the tree of knowledge, weighted heavily with apples. Surrounding this tree are dots. But these dots have become faces, just as much as data points and statistics represent real people. These are the patients and providers creating the workflows for Meaningful Use.”

All are Vivid paintings in which many issues are illustrated, and which actually don’t require words for the admirer to understand. It speaks to me.

Monday, December 5, 2011

Those of you who read Health Train know that I invite others to post here. Since I am a physician I cannot write as well as some devotees to journalism. I have many other sources listed on the blog in the lower portion of the right hand banner.

Later this week I will be featuring a new source.”Reforming Health” written by Naomi Freundlich an award-winning journalist, policy wonk and health advocate with over 25 years experience writing and thinking about health care, medicine, and the absolute necessity of creating an equitable, affordable and high-quality health care system that offers coverage to all who need it.

The discussion of health reform and policy must be in an open and transparent forum which Health Train Express attempts to encourage. The diversity of opinion will strengthen and increase chances for a successful outcome.

Health reform has already fallen victim to politicization and radicalized thinking which benefits no one. If it fails, everyone loses. No party will be immune from criticism and will suffer the consequences of irresponsible positioning and stereotyping the opposition.

Sunday, December 4, 2011

Dr Don Berwick resigned from his position at CMS this past Thursday.He resigned with little chance of being approved by congress in a long delayed hearing process. President Obama doomed him to failure with the ‘rush’ to appoint him to the position as head of CMS while Congress was not in session. Dr. Berwick is an outstanding physician and analytical expert, His experience and record as President of the Institute of Medicine (I.O.M.) portended significant accomplishments at Medicare and HHS. He is such an individual with strong convictions and integrity. He is now the first to admit the difficulty and challenge of framing and implementing changes in not only HHS,CMS but our entire Federal and State systems of government.

In a world of politics where there are no shades of gray, but only the rigidity of black and white differences of political opinion he was faced with his own unintended skeletons. In addition to his own opinions he was sabotaged by President Obama,, himself in the manner of his appointment, perceived by congress as a detour around the process. Congress had some serious questions to ask Dr Berwick, and had he the chance to answer critics, Obama may not have faced the intense resistance to implementing Obama care. In return Congress made it clear he would not be permanently appointed.

Deep partisan divides have stopped Congress from confirming Berwick since mid-October 2006, creating instability in the agency that oversees the Medicare and Medicaid programs. Obama installed Berwick in July 2010 as a recess appointment, which was heavily criticized by Republicans who accused the pediatrician of favoring health care rationing -- a charge Democrats dismissed as nonsense. (Senior Journal.com).

Those of you who read my opinions know that I was not a Berwick fans. However in his departing commentary he pointed out,

“The extremely high level of waste,” as exemplified by overtreatment of patients, failure to coordinate care, administrative complexity, burdensome rules, and fraud.

• “Much is done that does not help patients at all,” Dr. Berwick said, “and many physicians know it.”

• “I came with an agenda, I wanted to try to change the agency to be a force for improvement, covering one out of three Americans.”

• It’s a complex, complicated law. To explain it takes a while. To understand it takes an investment that I’m not sure the man or woman in the street wants to make or ought to make.”

• “We are a nation headed for justice, for fairness and justice in access to care,”

• “We are a nation headed for much more healing and much safer care. There is a moon shot here. But somehow we have not put together that story in a way that’s compelling.”

• “Government is more complex than I had realized. Government decisions result from the interactions of many internal stakeholders — different agencies and parts of government that, in many cases, have their own world views.”

• “The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open.”

• Berwick added, “Republicans have completed distorted my meaning. My point is that someone, like your health insurance company, is going to limit what you can get. That’s the way it’s set up. The government, unlike many private health insurance plans, is working in the daylight. That’s a strength.”

In another ‘interim appointment’ President Barack Obama is nominating Marilyn Tavenner (Washington Post Wonkblog) to succeed Donald M. Berwick as administrator of the Centers for Medicare and Medicaid Services.The current political climate on Capitol Hill may mean that Tavenner is just as likely to see her nomination stall.

Disclaimer

The opinions in this blog or other forms of social media are solely that of Gary M. Levin M.D. Dr. Levin has no financial interests in any medical devices which are discussed or which appear in the blog. Commentary taken from other sources are either quoted or referenced with attribution. Dr Levin does not endorse, nor give financial support to any political organizations.